Project Summary/Abstract This project will develop an innovative intervention to increase patient activation and communication self- efficacy so that adults with severe mental illnesses (SMI) can engage in shared decision-making (SDM) and optimize recovery outcomes. SDM -- a process in which patients and providers work collaboratively to make decisions -- is an ethical imperative and is critical for high-quality, recovery-oriented care. Yet, despite efforts to implement recovery-oriented care, people with SMI still have difficulty engaging as active partners in psychiatric treatment. Moreover, few SDM interventions have been developed specifically for people with SMI, and the most well-known is a highly resource-intensive program. The current proposal outlines a pilot effectiveness trial of a low-cost, high-innovation approach called GET PrEPD-Psychiatry (Goal Elicitation, Treatment Prioritization, & Electronically-Practiced Discussion). Originally developed to enhance SDM in chronic pain patients, GET PrEPD-Psychiatry participants receive individual in-person coaching to clarify/prioritize their goals, determine treatment preferences and rationale for these preferences, and develop skills to engage in SDM. Patients will practice these skills in online interactions with Virtual Providers, which will be tailored to patients' unique learning styles, thereby, enhancing skills mastery and communication self- efficacy. This pilot effectiveness trial includes three aims. First, the research team will adapt the Virtual Providers used in the original GET PrEPD for chronic pain for use in psychiatric decision-making ? they will do so by analyzing existing audio-recordings of 200 psychiatric visits collected in their prior NIMH-funded study. Content analysis will identify relevant conversations that will be used to program the online Virtual Providers, and a series of iterative tests with patients and feedback from consultants will refine the intervention. The second aim is to pilot test the adapted GET PrEPD-Psychiatry to establish feasibility and acceptability of the intervention in 40 adults with SMI in a community mental health center. Finally, the research team will identify potential mechanisms of change and examine preliminary outcomes of GET PrEPD-Psychiatry, hypothesizing that following participation in GET PrEPD-Psychiatry, patients will 1) report improved activation and communication self-efficacy, 2) demonstrate improved SDM in treatment sessions with their psychiatric providers, and 3) report improved self-management and recovery attitudes. Successful completion of this project will result in a new, highly scalable intervention that can be implemented across a range of psychiatric treatment settings to reach a large number of patients, directly addressing an NIMH strategic goal to develop innovative service delivery models. Following successful completion of this R34, the research team will be well- poised to evaluate mechanisms of change and recovery outcomes in a rigorous clinical trial of the intervention.